A supplement is any milk given to an infant in addition to direct feeding at mom’s breast. The first choice for supplementation is mom’s own expressed breastmilk, followed by pasteurized donor breastmilk. Hypoallergenic (extensively hydrolyzed) formulas are a third choice. Supplementation should never be water, sugar water, other animals’ milk or any other liquid¹.

Supplements should be given only when medically necessary¹. Infants who receive a supplement after breastfeeding might not breastfeed as often. If the breasts are not emptied when the infant is supplemented, mother’s milk supply may decrease because the infant is not draining the breast as often. Because milk production is a supply-demand phenomenon, a decrease in milk removal will send a message to the breasts to produce less milk. The goal of supplementation is to meet the infant’s needs while the supply at the breast is maintained, or increased if necessary.

Some common medical indications for supplementation are¹:

• Hypoglycemia that is not controlled by frequent breastfeeding, see section on hypoglycemia
• Jaundice, when the infant has evidence of insufficient calorie intake
• Physical or laboratory signs of dehydration
• Maternal illness requiring maternal infant separation
• Contraindications to breastfeeding (see the section on Contraindications and Precautions to Breastfeeding: Maternal Precautions and Infant Precautions)

The Academy of Breastfeeding Medicine’s ‘Clinical Protocol #3 on Hospital Guidelines for the Use of Supplementary Feedings in the Healthy Term Breastfed Neonate’ can be found at https://abm.memberclicks.net/assets/DOCUMENTS/PROTOCOLS/3-supplementation-protocol-english.pdf